@article{ref1,
title="Delayed toxic acetaminophen level after initial four hour nontoxic level",
journal="Journal of toxicology - clinical toxicology",
year="1994",
author="Tighe, T. V. and Walter, F. G.",
volume="32",
number="4",
pages="431-434",
abstract="Antidotal therapy for acetaminophen poisoning is routinely based on a single acetaminophen level obtained four or more hours after ingestion. Some experts recommend additional acetaminophen levels if there are coingestants. This case report describes a 20-year-old woman who ingested acetaminophen 13 g, propoxyphene napsylate 2 g and naproxen sodium 3.75 g. A 4.5 h acetaminophen level was 83.5 mg/L (nontoxic). A 6.75 h acetaminophen level was 124.6 mg/L (toxic). The patient was treated with N-acetylcysteine and recovered without sequelae. This is the first published report of a delayed toxic acetaminophen level occurring after an initial nontoxic level. Although rare, the possibility of a delayed peak acetaminophen level merits consideration, particularly with coingestions that delay gastric emptying.<p /><p>Language: en</p>",
language="en",
issn="0731-3810",
doi="",
url="http://dx.doi.org/"
}